Authors:Dale Coffey, M Chance Spalding, Blake V Conklin, John Kuckelman, Michael S O&#39;MaraPages: 243 - 247Abstract: Dale Coffey, M Chance Spalding, Blake V Conklin, John Kuckelman, Michael S O'MaraInternational Journal of Academic Medicine 2017 3(2):243-247Background: Damage control laparotomy with temporary abdominal closure has become routine in trauma surgery. This technique is associated with complications. Increasing prevalence of this procedure leads to concern over abdomens being left open due to decision points other than patient factors, such as routine, time of day, or surgeon fatigue. We hypothesize that time of day contributes to the decision to leave the initial trauma laparotomy open.Materials and Methods: This was a retrospective chart review of 527 patients over 5 years. Patients with emergent damage control laparotomies with fascia not closed were included in the open abdomen group. Those patients who had fascia primarily closed were used as the control group. Patient demographics, injury factors, time of operation, and time to fascial closure were evaluated.Results: Time of day was not predictive of the decision to leave a patient open. In a logistic regression model of these factors, only patient age (P = 0.002), injury severity score (P < 0.0001), and the number of abdominal organs with an injury grade of three or more (P = 0.0014) predicted the abdomen would be left open. Of the patients with initially open abdomen, 101 (72.1%) survived and 77 (76.2%) of those achieved primary fascial closure. Mean time to closure was 3.7 days.Conclusion: The decision to perform damage control surgery and leave an abdomen open appears to be consistent throughout the day and to be dependent on the patient factors. Time of day does not seem to be a contributing factor. Fascial closure, done on average 3.7 days after the initial procedure, does not vary based on the demographic or injury factors. It appears that closure occurs as part of a routine or on convenience. An opportunity may exist to identify a subset of the open abdomen patients that could return to the operating room for earlier definitive closure, thereby lowering the risk of complications.The following core competencies are addressed in this article: Patient care, Practice based learning and improvement, and Systems-based practice.Citation: International Journal of Academic Medicine 2017 3(2):243-247PubDate: Tue,9 Jan 2018DOI: 10.4103/2455-5568.222475Issue No:Vol. 3, No. 2 (2018)

Authors:Nicolas Grundmann, Yonatan Yohannes, Mark Silverberg, Jayaraj Mymbilly Balakrishnan, S Vimal Krishnan, Bonnie ArquillaPages: 248 - 255Abstract: Nicolas Grundmann, Yonatan Yohannes, Mark Silverberg, Jayaraj Mymbilly Balakrishnan, S Vimal Krishnan, Bonnie ArquillaInternational Journal of Academic Medicine 2017 3(2):248-255Background: Internationally, emergency medicine (EM) physicians are vulnerable to both physical and verbal violence. Few studies have examined or compared perceptions and the impacts of workplace violence in India and the United States (US).Objectives: To assess the perceived incidence of workplace violence and its implications on sleep, missed days of work, fear in the workplace, and overall job satisfaction.Materials and Methods: This was an anonymous, prospective, cross-sectional electronic survey of EM residents and physicians. A cohort of physicians in the US was matched to a cohort of physicians in India.Results: Overall, 286 physicians were eligible to participate, 177 responded (98 people from the US and 79 from Indian, for a 62% total response rate). In the US 100% of respondents witnessed verbal violence, whereas only 23% of verbal abuse cases were reported. In India, 89% of respondents witnessed verbal abuse, 46% of cases were reported. Respondents in the US both witnessed and experienced significantly more verbal and physical abuse (P < 0.001). Despite the differences in perceived rates of violence, there were no significant differences between country cohorts regarding the consequences of these incidents. This includes self-reported sleep, missed days of work, and fear of going to the workplace. US respondents were less satisfied with their jobs due to workplace violence as compared to their Indian colleagues (P = 0.041).Conclusion: ED workplace violence is common internationally, underreported, and results in poor job satisfaction, workplace fear, and loss of sleep.The following core competencies are addressed in this article: Patient care, Professionalism, Systems-based practice.Citation: International Journal of Academic Medicine 2017 3(2):248-255PubDate: Tue,9 Jan 2018DOI: 10.4103/2455-5568.222476Issue No:Vol. 3, No. 2 (2018)

Authors:Omayma A Kishk, Kristen A Stafford, Mehrnaz Pajoumand, Carla P Williams, Kerri A Thom, Zachary N Kon, Daniel L Herr, Anthony AmorosoPages: 256 - 262Abstract: Omayma A Kishk, Kristen A Stafford, Mehrnaz Pajoumand, Carla P Williams, Kerri A Thom, Zachary N Kon, Daniel L Herr, Anthony AmorosoInternational Journal of Academic Medicine 2017 3(2):256-262Context and Aims: Primary objective of this study was to estimate time to infection after extracorporeal membrane oxygenation (ECMO) initiation among patients who received prophylactic antibiotics compared to those who did not.Subjects and Methods: This retrospective cohort study included adult patients initiated on ECMO between February 1, 2009, and June 30, 2012, in Intensive Care Units at an 816-bed tertiary care hospital.Results: Prophylaxis defined as an antibiotic initiated at start of ECMO without other bacterial infectious indications was categorized into three levels: (1) No prophylaxis, (2) single antibiotic, and (3) combination two or more antibiotics with activity against methicillin-resistant Staphylococcus aureus and Gram-negative bacteria. Of the 96 patients included, 37 (39%) patients acquired a sterile site infection; 17 of which were caused by of multidrug-resistant organisms. There was no significant difference in the proportion of new infections by antibiotic exposure group. By 500 h on ECMO, all patients had a 60% probability of developing infection. There was a trend that patients on combination antibiotics were less likely to develop a sterile site infection than patients who were not exposed to antibiotics after adjusting for age and comorbid illnesses (adjusted hazard ratio 0.44, 95% confidence interval 0.17–1.13) (P = 0.09).Conclusions: Patients on ECMO on single and combination antibiotic regimens demonstrated no significant difference in the hazard for the development of a new sterile site infection compared to no antibiotic group.The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, Systems-based practice.Citation: International Journal of Academic Medicine 2017 3(2):256-262PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_90_16Issue No:Vol. 3, No. 2 (2018)

Authors:Vimal Koshy Thomas, Siju Varghese Abraham, Jayaraj Mymbilliy Balakrishnan, S Vimal Krishnan, Ajay Amalakat, Babu Urumese PalattyPages: 263 - 267Abstract: Vimal Koshy Thomas, Siju Varghese Abraham, Jayaraj Mymbilliy Balakrishnan, S Vimal Krishnan, Ajay Amalakat, Babu Urumese PalattyInternational Journal of Academic Medicine 2017 3(2):263-267Background: Emergency medicine (EM) as a specialty in India is at its infancy. Point-of-care ultrasound (POCUS) is an indispensable tool for the emergency physician (EP). We sought to determine the current experience and resources of POCUS training among EM teaching programs in India.Methods: At a national EM board review course, a survey was carried out among 41 residents from 15 different teaching institutes across seven states of India. The survey consisted of questions pertaining to their experience and knowledge in performing basic and advanced POCUS examinations and its utilization in their department.Results: Most residents (90.2%) were of the opinion that POCUS is an indispensable tool for the EP. All residents had access to an ultrasound (US) machine, with 90.2% having at least one dedicated machine in their department. 12.1% of the residents utilized POCUS less than five times a day while 14.6% reported using US more than twenty times a day. 68.5% of residents identified the major modality of learning POCUS was from a mentor, and about one-third were exclusively dependent on it. The least utilized sources were books and lectures (19%). Extended focused assessment with sonography in trauma (EFAST) was the most frequently performed examination (95%) and was performed with highest level of confidence. Among the advanced examinations, residents knew how to perform and interpret airway (53.7%) and renal sonography (53.7%) the most while they were least familiar with ocular sonography (19%). 70.1% residents reported that POCUS was utilized for facilitating vascular access, 53.7% for nerve blocks, and paracentesis around 19%. Only 46% reported that other departments rely on their findings to make clinical decisions.Conclusion: POCUS was utilized by the residents for different diagnostic examinations and interventions, with the most common being EFAST. The most common learning source of POCUS was from hands-on training by a mentor. There exists a need for guidelines or standardization of POCUS in the EM curriculum to achieve resident competency.The following core competencies are addressed in this article: Interpersonal skills and communication, Medical knowledge, Patient care, Systems-based practice.Citation: International Journal of Academic Medicine 2017 3(2):263-267PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_77_16Issue No:Vol. 3, No. 2 (2018)

Authors:Parampreet Kaur, Jill StoltzfusPages: 268 - 270Abstract: Parampreet Kaur, Jill StoltzfusInternational Journal of Academic Medicine 2017 3(2):268-270As a key component of scientific research, hypothesis testing incorporates a null hypothesis (H0) of no difference in a larger population and an alternative hypothesis (H1or HA) that becomes true when the null hypothesis is shown to be false. Two potential types of statistical error are Type I error (α, or level of significance), when one falsely rejects a null hypothesis that is true, and Type II error (β), when one fails to reject a null hypothesis that is false. To reduce Type I error, one should decrease the pre-determined level of statistical significance. To decrease Type II error, one should increase the sample size in order to detect an effect size of interest with adequate statistical power. Reducing Type I error tends to increase Type II error, and vice versa. Type III error, although rare, occurs when one correctly rejects the null hypothesis of no difference, but does so for the wrong reason.The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.Citation: International Journal of Academic Medicine 2017 3(2):268-270PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_92_17Issue No:Vol. 3, No. 2 (2018)

Authors:Luther K Fleury, Neal P Johnson, Michael I SilbermanPages: 271 - 273Abstract: Luther K Fleury, Neal P Johnson, Michael I SilbermanInternational Journal of Academic Medicine 2017 3(2):271-273Esophageal rupture is a rupture of the esophageal wall usually brought on by a sudden increase in intraluminal esophageal pressure. This disease is life threatening, and the mortality of patients is time dependent. We describe a case of an elderly woman who presented to the emergency department on 2 consecutive days, the 1st day with acute lumbar back pain and the 2nd day critically ill with altered mental status, hypotension, and shortness of breath. The patient was ultimately diagnosed with spontaneous esophageal perforation.The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, and Patient care.Citation: International Journal of Academic Medicine 2017 3(2):271-273PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_27_17Issue No:Vol. 3, No. 2 (2018)

Authors:Rodrigo Duarte-Chavez, Lauren E Stone, Mark W Fegley, Avani Amin, Ayaz Matin, Santo Longo, Sudip NandaPages: 285 - 290Abstract: Rodrigo Duarte-Chavez, Lauren E Stone, Mark W Fegley, Avani Amin, Ayaz Matin, Santo Longo, Sudip NandaInternational Journal of Academic Medicine 2017 3(2):285-290Due to the great increase of international travel and emigration, physicians the world over may face serious diagnostic challenges, resulting from the inability to recognize diseases totally alien to their culture, and diseases common to their culture but presenting with previously unseen complications. Over the past 50 years, the frequency of Mycobacterium tuberculosis (MT) infections, arising in the native populations of the United States and other industrialized countries, has been declining. However, the rate of infections in under-developed nations remains at a very high rate. Tuberculosis (TB) can occur in any organ or tissue and can mimic many other diseases. We present the case of a 95-year-old male immigrant from India, with abdominal pain and chronic anemia. Investigation of his abdominal pain revealed a large pancreatic mass with possible hepatic metastases consistent with pancreatic cancer. Fine-needle aspiration biopsy of the mass obtained by endoscopic ultrasound, demonstrated granulomatous inflammation and yielded cultures positive for MT. Antitubercular therapy resulted in progressive resolution of the pancreatic mass and the anemia. The initial clinical impression and radiological findings, in a 95-year-old patient, may well have prompted a harmful decision to opt for comfort care only. This was avoided in our patient by adherence to the strict standard of pursuing a definitive tissue diagnosis for all “masses of unknown origin.” The merits of this case report are in the thorough discussion and illustration of the unusual pathogenesis of TB of the elderly, the imperative of assessing socioeconomic status of patients, and the diagnostic considerations required to evaluate extrapulmonary TB.The following core competencies are addressed in this article: Patient care and Medical knowledge.Citation: International Journal of Academic Medicine 2017 3(2):285-290PubDate: Tue,9 Jan 2018DOI: 10.4103/2455-5568.222477Issue No:Vol. 3, No. 2 (2018)

Authors:Kristine Cornejo, Pritiben Patel, Swomya Bal, Pamela L ValenzaPages: 291 - 294Abstract: Kristine Cornejo, Pritiben Patel, Swomya Bal, Pamela L ValenzaInternational Journal of Academic Medicine 2017 3(2):291-294Gitelman syndrome (GS) is an autosomal recessive tubular disorder with an incidence of 1 in 40,000. It is characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, with secondary hyperreninemia, which can easily be managed with a potassium (K+) sparing diuretic if correctly recognized, and with an understanding of the pathophysiology. A 17-year-old male patient presented to the emergency department after an episode of tonic-clonic seizure activity and subsequent loss of consciousness. Diagnosis of GS was made following persistent hypokalemia despite adequate repletion and further laboratory analysis. The patient was placed on a K+-sparing diuretic and had no further seizure activity. This case illustrates the importance of proper clinical and diagnostic evaluation of electrolyte abnormalities in all patients, especially in younger patients in whom early diagnosis can be crucial in preventing future complications.The following core competencies are addressed in this article: Medical knowledge, Patient care.Citation: International Journal of Academic Medicine 2017 3(2):291-294PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_39_17Issue No:Vol. 3, No. 2 (2018)

Authors:Maryam Saeed, Mamta Swaroop, Bhakti Hansoti, Harry L Anderson, Bonnie Arquilla, Michael S Firstenberg, Manish Garg, Sagar C Galwankar, Elizabeth Krebs, Gregory L Peck, Joseph V Sakran, James Salway, Sherwin P Schrag, Ziad C Sifri, Tamara Worlton, Stanislaw P StawickiPages: 295 - 324Abstract: Maryam Saeed, Mamta Swaroop, Bhakti Hansoti, Harry L Anderson, Bonnie Arquilla, Michael S Firstenberg, Manish Garg, Sagar C Galwankar, Elizabeth Krebs, Gregory L Peck, Joseph V Sakran, James Salway, Sherwin P Schrag, Ziad C Sifri, Tamara Worlton, Stanislaw P StawickiInternational Journal of Academic Medicine 2017 3(2):295-324The Academic International Medicine (AIM) Congress (the Congress) is the official meeting of the American College of Academic International Medicine, a United States organization dedicated specifically to connecting academic physicians from diverse areas of expertise toward the common goals of sustainable global medical outreach and multinational clinical research and education. The organization's main focus is to promote AIM and to establish a platform for individuals, academic institutions, and a broad range of organizations to collaborate and work collectively to create a foundation for efficient and sustainable resource sharing. World-renowned experts and speakers from the AIM community attended and participated in the 2017 Congress held in Clearwater Beach, Florida, from July 28 to July 30, 2017. This year's Congress also included the participation of the Global Association of Physicians of Indian Origin, the American Association of Physicians of Indian Origin, and the OPUS 12 Foundation, Inc. Finally, the Congress featured the inaugural Annual Scientific Forum as a platform for exchanging scientific knowledge among academic experts. This report presents an overview of this major academic event, including the full listing of podium presentations from the 2017 Scientific Forum.The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice, Interpersonal and communication skills, Professionalism.Citation: International Journal of Academic Medicine 2017 3(2):295-324PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_94_17Issue No:Vol. 3, No. 2 (2018)

Authors:Kristine V Cornejo, Roopa Anmolsingh, Najmus Liang, Ching-Huey Chu, Raymond S BuchPages: 325 - 327Abstract: Kristine V Cornejo, Roopa Anmolsingh, Najmus Liang, Ching-Huey Chu, Raymond S BuchInternational Journal of Academic Medicine 2017 3(2):325-327An epidermal cyst is a benign intradermal lesion and may occur anywhere in the body. Carcinoma arising in a preexisting epidermal cyst is uncommon. Cutaneous squamous cell carcinoma is the second most common form of nonmelanoma skin cancer. A 65-year-old male with light skin pigmentation presented with chronic lower back pain secondary to a large “cauliflower-like” mass over his left flank, which started out as a “cheesy tumor” 20 years ago. The patient reported that the mass had recently begun to drain foul-smelling mucous and bloody discharge and was growing in size. This image illustrates the importance of proper comprehensive biannually or annually history and physical examination as screening tools for skin cancer. Primary care physicians are encouraged to educate their patients on the use of sunscreen containing zinc oxide and conducting regular self-examinations.The following core competencies are addressed in this article: Medical knowledge, Patient care.Citation: International Journal of Academic Medicine 2017 3(2):325-327PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_23_17Issue No:Vol. 3, No. 2 (2018)

Authors:Reddy RavikanthPages: 328 - 330Abstract: Reddy RavikanthInternational Journal of Academic Medicine 2017 3(2):328-330Esthesioneuroblastoma was first described by Bergerand Lucin 1924, accounting for 3% of all intranasal tumors. Clinical staging system was proposed by Kadish et al. in 1976 and is used as the prognosis indicator. CT and magnetic resonance imaging are complementary examinations used for the diagnosis, staging and follow-up.The following core competencies are addressed in this article: Medical knowledge, Patient care.Citation: International Journal of Academic Medicine 2017 3(2):328-330PubDate: Tue,9 Jan 2018DOI: 10.4103/IJAM.IJAM_24_17Issue No:Vol. 3, No. 2 (2018)